Eligibility Verification & Prior Authorization
Confirm patient coverage, benefits, and prior-authorization requirements before service to prevent denials.
Precise billing for physician practices — outpatient visits, consultations, procedures, follow-ups, and preventive care — with certified coders, clean claim submission, and denial recovery.
Confirm patient coverage, benefits, and prior-authorization requirements before service to prevent denials.
Accurate entry of patient demographics, services rendered, procedures, diagnostics and supply usage for clean claims.
Certified coding for office visits, procedures, preventive care, consultations, follow-ups, and complex services.
Submit claims via EDI or paper, monitor status, track remittance and payer responses.
Process remittances, patient payments, adjustments, and reconcile accounts to close out claims accurately.
Investigate denied or rejected claims, correct documentation or coding issues, re-submit or appeal to recover revenue.
Regular follow-up on outstanding claims, clean-up of aged AR, and proactive collections for improved cash flow.
Financial dashboards, denial-rate tracking, revenue per provider, productivity reports and cash-flow forecasting.
Periodic audits to ensure documentation meets payer and regulatory standards — reducing audit risk and denials.
Collect patient data and verify coverage before appointment.
Log services, procedures, supplies, diagnostics provided during visit.
Assign correct ICD-10, CPT, HCPCS codes, apply modifiers when required.
Submit clean claims electronically or via paper, depending on payer requirements.
Process remittances, patient payments, write-offs and adjustments.
Investigate denials, submit appeals with corrected documentation or coding where needed.
Regular aging follow-up, patient reminders, and payer follow-up for delayed claims.
Provide performance analytics, denial trends, revenue metrics and improvement recommendations.